Medicare Sales Allegation

[pdbrian]

I just got a sales allegation regarding a client stating that they did not agree to move to the plan I was selling (Humana). This person was a client I had written earlier this year and when I called her, discovered she had been switched a couple months after I wrote her. I compared both plans and she agreed to go back to the original plan for 2023.
I enrolled her in Sunfire and thought we were good to go, however yesterday I received an email regarding a sales allegation being made against me. I’ve been in the business for over 25 years and this the first time I’ve had any kind of complaint lodged against me.
What really complicates the issue is that I used Vocaroo software to record the call and when I play it, it is just noise.
What can I expect from this? I’ve explained the situation and conversation from memory, but it’s difficult to prove without the recording. Any thoughts?

 

[policywunk]

I just got a sales allegation regarding a client stating that they did not agree to move to the plan I was selling (Humana). This person was a client I had written earlier this year and when I called her, discovered she had been switched a couple months after I wrote her. I compared both plans and she agreed to go back to the original plan for 2023.
I enrolled her in Sunfire and thought we were good to go, however yesterday I received an email regarding a sales allegation being made against me. I’ve been in the business for over 25 years and this the first time I’ve had any kind of complaint lodged against me.
What really complicates the issue is that I used Vocaroo software to record the call and when I play it, it is just noise.
What can I expect from this? I’ve explained the situation and conversation from memory, but it’s difficult to prove without the recording. Any thoughts?

I believe it would be a slap on wrist for no/bad recording however it could be an issue if you say you called her after she was in the process of disenrolling.

 

[pdbrian]

No, I called her during AEP not knowing that she had already disenrolled from the plan I sold her.

 

[sshafran]

I just got a sales allegation regarding a client stating that they did not agree to move to the plan I was selling (Humana). This person was a client I had written earlier this year and when I called her, discovered she had been switched a couple months after I wrote her. I compared both plans and she agreed to go back to the original plan for 2023.
I enrolled her in Sunfire and thought we were good to go, however yesterday I received an email regarding a sales allegation being made against me. I’ve been in the business for over 25 years and this the first time I’ve had any kind of complaint lodged against me.
What really complicates the issue is that I used Vocaroo software to record the call and when I play it, it is just noise.
What can I expect from this? I’ve explained the situation and conversation from memory, but it’s difficult to prove without the recording. Any thoughts?

I'd imagine if you have a good history (25 yr in the business is pretty long!) the carrier should take slow steps in taking their word over your word.

 

[DonP]

I just got a sales allegation regarding a client stating that they did not agree to move to the plan I was selling (Humana). This person was a client I had written earlier this year and when I called her, discovered she had been switched a couple months after I wrote her. I compared both plans and she agreed to go back to the original plan for 2023.
I enrolled her in Sunfire and thought we were good to go, however yesterday I received an email regarding a sales allegation being made against me. I’ve been in the business for over 25 years and this the first time I’ve had any kind of complaint lodged against me.
What really complicates the issue is that I used Vocaroo software to record the call and when I play it, it is just noise.
What can I expect from this? I’ve explained the situation and conversation from memory, but it’s difficult to prove without the recording. Any thoughts?

Since you did on the phone there’s no way without a recording to prove what your saying is true . If this was done face to face no issue as there’s no recording as it’s your word against theres . Also another issue is she wasn’t your client to contact as she was disenrolled . You should always scour your future terms in vantage . But I’d be suprised if you get anything other than a slap on the wrist . 100-1 says this was agent driven complaint . He saw his client was disenrolling 12-31 and went out to save it and instructed her to file complaint .

 

[steve3752]

Did she not sign something electronically saying she agreed to the plan you enrolled her in? I would guess she did. So how can she claim you did something she did not authorize? Recorded or not. She signed.

 

[policywunk]

No, I called her during AEP not knowing that she had already disenrolled from the plan I sold her.

Since you did on the phone there’s no way without a recording to prove what your saying is true . If this was done face to face no issue as there’s no recording as it’s your word against theres . Also another issue is she wasn’t your client to contact as she was disenrolled . You should always scour your future terms in vantage . But I’d be suprised if you get anything other than a slap on the wrist . 100-1 says this was agent driven complaint . He saw his client was disenrolling 12-31 and went out to save it and instructed her to file complaint .

The carriers are not stupid they know agents are alerted of disenrollments by chargebacks ( if it's a policy on renewal or an AEP application then there is more plausible deniability ) but even if they don't believe you didn't know she had disenrolled it is very unlikely there would be severe penalties for first time marketing rule violation .

 

[titeye]

The carriers are not stupid....

I beg to differ. One of my recorded MAPD enrollments was audited by the carrier and I was reprimanded for not offering the member an option of how they wished to pay their premium (direct bill, SS, bank draft, etc.). "IT IS A ZERO PREMIUM PLAN, Sir Ma'am!!!"
In so many words, the carrier was advising me to confuse the member by asking them how they preferred to make monthly payments on something that costs $0.00 monthly. Was I supposed to ask the member if they wanted $0.00 coming out of their SS, or ask for their bank account number for the carrier to draft $0.00, so the member doesn't lose their plan for nonpayment?
Help me, please! What did I miss?

 

[policywunk]

I beg to differ. One of my recorded MAPD enrollments was audited by the carrier and I was reprimanded for not offering the member an option of how they wished to pay their premium (direct bill, SS, bank draft, etc.). "IT IS A ZERO PREMIUM PLAN, Sir Ma'am!!!"
In so many words, the carrier was advising me to confuse the member by asking them how they preferred to make monthly payments on something that costs $0.00 monthly. Was I supposed to ask the member if they wanted $0.00 coming out of their SS, or ask for their bank account number for the carrier to draft $0.00, so the member doesn't lose their plan for nonpayment?
Help me, please! What did I miss?

I agree they have stupid rules they have to enforce but that is dictated by CMS.I was referring to the fact that they know brokers are very motivated by money and it is unlikely that an agent isn't aware of a disenrollment after they see a chargeback.Not that they would terminate someone for this marketing violation but if the OP claims he had no awareness of prospects disenrollment it could put in to questions the veracity of what was or wasn't said during enrollment process which is the main issue.

 

[DonP]

I agree they have stupid rules they have to enforce but that is dictated by CMS.I was referring to the fact that they know brokers are very motivated by money and it is unlikely that an agent isn't aware of a disenrollment after they see a chargeback.Not that they would terminate someone for this marketing violation but if the OP claims he had no awareness of prospects disenrollment it could put in to questions the veracity of what was or wasn't said during enrollment process which is the main issue.

This is were difference in carriers come in . Supposedly United doesn’t provide termination of enrollment data because they don’t want the agent contacting . But on humana vantage you can see future terms into month end . In reality Humana’s agreeing these are your clients until it goes inactive the 1st of the following month . I save many of those as a ton of clients don’t realize they were switched .at the very least i alert them and if they say they went with better plan . I explain the difference and if they say i want my new plan. I say that fine take care . But I wasn’t them to know the truth in the benefits of both so they understand